Hyperlipidemia 3 (start of meds)

Question 1

What do ACC/AHA lipid guidelines say about screening?

Answer 1

Aduls age 20+ years

Question 2

Is there a specific targeted goal for TC and LDL under ACC/AHA guidelines?

Answer 2

No

Question 3

The following are ______ benefit groups according to ACC/AHA guidelines:

1. Secondary prevention in patients w/ clinical ASCVD
2. Severe hypercholesterolemia (LDL>190)
3. Pts w/ DM
4. Primary prevention based on risk

Answer 3

Statin benefit groups

Question 4

What is the goal for treatment for patients w/ clinical ASCVD (statin benefit group #1) according to ACC/AHA guidelines?

Answer 4

1. reduce LDL with high-intensity statin therapy (or maximally tolerated statin therapy)
2. 50% reduction

Question 5

What could you consider in patients with very high-risk ASCVD ( part of statin benefit group #1) according to ACC/AHA guidelines?

Answer 5

Consider adding non-statins to lower LDL below 70 mg/dL

Question 6

The following are considered high risk conditions according to which guidelines?

1. Age 65+
2. Familial hypercholesterolemia
3. CABG or PCI outside of the ASCVD event(s)
4. Diabetes mellitus
5. HTN
6. CKD (eGFR 15-59)
7. Current smoking
8. LDL remains ≥ 100 despite statin and ezetimibe
9. CHF

Answer 6

ACC/AHA guidelines

Question 7

According to ACC/AHA guidelines, how do you tx statin benefit group #2: Severe hypercholesterolemia (LDL >190)

Answer 7

Maximally tolerated statin therapy

Question 8

According to ACC/AHA guidelines, how do you treat a 40-75y/o patient w/ history of DM (statin benefit group #3)?

Answer 8

moderate intensity statin therapy (regardless of 10yr ASCVD risk)

Question 9

According to ACC/AHA guidelines, how do you change your treatment plan in patient’s with DM that have Multiple ASCVD risk factors?

Answer 9

Consider high intensity statin with goal of reducing LDL by 50% or more

Question 10

According to ACC/AHA guidelines, how do you change your treatment plan in patient’s with DM that have a 10 year risk of greater than or equal to 20%?

Answer 10

consider adding ezitimibe to maximally tolerated statin to reduce LDL by 50% or more

Question 11

ACC/AHA guidelines- Statin Benefit group #3: Pt’s w/ DM:

How do you tx a patient that is 20-39y/o w/ DM risk enhancers?

Answer 11

Consider initiating statin therapy

(ACC/AHA has no real recommendation for younger DM patients)

Question 12

The following are _______ specific risk enhancers:

1. Long duration of DM
2. Albuminuria ≥ 30 mcg albumin/mg creatinine
3. eGFR < 60
4. Retinopathy
5. Neuropathy
6. ABI < 0.9

Answer 12

Diabetes specific risk enhancers

(ACC/AHA guidelines- Statin Benefit group #3: Pt’s w/ DM)

Question 13

ACC/AHA guidelines for Statin benefit group #4: Primary prevention based on risk–>

<5%

“low risk”

Answer 13

Risk discussion:

emphasize lifestyle to reduce risk factors (Class I)

Question 14

ACC/AHA guidelines for Statin benefit group #4: Primary prevention based on risk–>

5% - <7%

“Borderline risk”

Answer 14

Risk discussion:

If risk enhancers present then risk discussion regarding moderate-intensity statin therapy (class IIb)

Question 15

ACC/AHA guidelines for Statin benefit group #4: Primary prevention based on risk–>

>7.5% - <20%

“Intermediate risk”

Answer 15

Risk discussion:

Moderate intensity statin to reduce LDL by 30%-49% (Class I)

Question 16

ACC/AHA guidelines for Statin benefit group #4: Primary prevention based on risk–>

>20%

“High Risk”

Answer 16

Risk discussion:

Initiate high intensity statin to reduce LDL >50% (class I)

Question 17

Which of the following is considered a negative risk factor (i.e. lowers risk) for CVD?

A. <45y/o for man or <55 for a woman

B. HDL >60mg/dL

C. HTN treated to goal

D. Negative family hx for heart disease

Answer 17

B. HDL >60mg/dL

Question 18

Which of the following correctly describes one of the criteria that is a component of metabolic syndrome?

A. Triglycerides >130

B. Fastin glucose >100

C. HDL in a man is <50

D. Waist circumference in a woman is >30”

Answer 18

B. Fastin glucose >100

Question 19

What are the 3 main steps in approaching therapeutic lifestyle changes?

Answer 19

1. Start small
2. Encourage patient to make the goal
3. Follow up (4 weeks)

Question 20

What is typical success of therapeutic lifestyle changes?

Answer 20

5-10% LDL reduction

Question 21

The following are some _______ therapeutic lifestyle changes recommended by ACC/AHA?

1. AHA low-fat diet
2. CardioSmart
3. Mediterranean diet
4. increase soluble fiber
5. Plant stanols and sterols
6. Garlic, soy protein, vitamin C, pecans
7. Antioxidants (fruits, vegetables)

Answer 21

Dietary

All of the above can lower LDL by up to 30%

Question 22

What is the MOA of Statins (HMG-CoA reductase inhibitors)?

Answer 22

•inhibit the rate-limiting enzyme in the formation of cholesterol

Question 23

Are statins best dosed at night or in the morning?

Answer 23

At night because cholesterol is synthesized at night

Question 24

What do statans reduce?

Answer 24

•Reduces fatal and non-fatal MI, incidence of CVA and all cause mortality